Abdullah Mai, Elkady Ahmed, Bushnag Areej, Seddeq Yehya, Alkutbi Abdullah
Neurology Department, International Medical Centre, Jeddah, SAU.
Neurology Department, Saudi German Hospital, Jeddah, SAU.
Cureus. 2020 Apr 2;12(4):e7515. doi: 10.7759/cureus.7515.
Lumbar puncture (LP) is done daily for both spinal anesthesia and emergency cases for cerebrospinal fluid (CSF) analysis. Subdural hemorrhage (SDH) is a rare but severe complication following diagnostic LP, which could be potentially fatal, and early diagnosis may be life-saving. We present a 28-year-old female patient who presented to our emergency department with a headache, fever, and vomiting, with normal initial laboratory and imaging. Diagnostic lumbar puncture was done to exclude central nervous system infection. After CSF results and cultures were negative, and nasal influenza B detected, medication was started and she was discharged home. Three days post-procedure, she was complaining of a severe, persistent headache and a head computed tomography (CT) was done, which revealed acute SDH. Extensive workup searching for the cause of SDH was negative, and with a stationary course of SDH, she has discharged home again with a diagnosis of SDH post LP complication. In conclusion, a headache post LP is common and usually benign and self-limited. Severe persistent headache that is not positional and doesn't respond to analgesics with caffeine should be considered a red flag after LP and should be investigated carefully for other possibilities such as SDH.
腰椎穿刺（LP）每天都用于脊髓麻醉和脑脊液（CSF）分析的急诊病例。硬膜下出血（SDH）是诊断性LP后一种罕见但严重的并发症，可能会危及生命，早期诊断可能挽救生命。我们报告一名28岁女性患者，她因头痛、发热和呕吐就诊于我们的急诊科，初始实验室检查和影像学检查均正常。进行诊断性腰椎穿刺以排除中枢神经系统感染。脑脊液检查结果和培养均为阴性，检测出甲型流感病毒B，开始用药后她出院回家。术后三天，她主诉严重、持续性头痛，进行了头部计算机断层扫描（CT），结果显示为急性硬膜下出血。对硬膜下出血病因进行的广泛检查结果均为阴性，鉴于硬膜下出血病情稳定，她再次出院，诊断为腰椎穿刺后硬膜下出血并发症。总之，腰椎穿刺后头痛很常见，通常为良性且自限性。腰椎穿刺后出现严重持续性头痛且与体位无关、对含咖啡因的镇痛药无反应，应被视为危险信号，应仔细排查其他可能性，如硬膜下出血。
